| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | .25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120404 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 9 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 10 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 11 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 12 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 13 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 14 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 15 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 16 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 17 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 18 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 19 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 20 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100323 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100323 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 26 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 27 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 28 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 29 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20110221 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20110221 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 30 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 31 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 32 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 33 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 34 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 35 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 36 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 37 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 38 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 39 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 40 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 41 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 42 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 43 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 44 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 45 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 46 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 47 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 48 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 49 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 50 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 51 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 52 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 53 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 54 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 55 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 56 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 57 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 58 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 59 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 60 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 61 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 62 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 63 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 64 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 65 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 67 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 68 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 69 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 70 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 71 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 72 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 73 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 78 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 79 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 80 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 81 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 82 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 83 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 84 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 85 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 86 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 87 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 88 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 89 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 90 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 91 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 92 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 93 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20111123 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20111123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 94 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 95 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20120523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20120523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 98 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 99 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | N | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 101 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30982-3 | |
| OBX.3.2 | Text | Reason code | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20101023 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20101023 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 102 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 103 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 104 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 105 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20121122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20121122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160131 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Juana Mariana Gonzales Display Reconcile Update Immunization Information | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 123456 | Juana Mariana Gonzales | 11/23/2009 | Female | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B Peds NOS | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | 11/23/2009 | YES | Complete | ||
| Hep B Peds NOS | hepatitis B vaccine, unspecified formulation | 01/15/2010 | YES | Complete | ||
| Hep B Peds NOS | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | 10/30/2010 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | 01/22/2010 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | 03/23/2010 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | 05/22/2010 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | 02/21/2011 | YES | Complete | ||
| Hib, unspecified formulation | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | 01/22/2010 | YES | Complete | ||
| Hib, unspecified formulation | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | 03/23/2010 | YES | Complete | ||
| Hib, unspecified formulation | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | 05/22/2010 | YES | Complete | ||
| Hib, unspecified formulation | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | 02/21/2010 | YES | Complete | ||
| poliovirus vaccine, inactivated | poliovirus vaccine, inactivated | 01/22/2010 | YES | Complete | ||
| poliovirus vaccine, inactivated | poliovirus vaccine, inactivated | 03/23/2010 | YES | Complete | ||
| pneumococcal, unspecified formulation | pneumococcal conjugate vaccine, 13 valent | 01/21/2010 | YES | Complete | ||
| pneumococcal, unspecified formulation | pneumococcal conjugate vaccine, 13 valent | 03/23/2010 | YES | Complete | ||
| pneumococcal, unspecified formulation | pneumococcal conjugate vaccine, 13 valent | 05/22/2010 | YES | Complete | ||
| pneumococcal, unspecified formulation | pneumococcal conjugate vaccine, 13 valent | 02/21/2011 | YES | Complete | ||
| rotavirus, unspecified formulation | rotavirus, live, monovalent vaccine | 01/22/2010 | YES | Complete | ||
| rotavirus, unspecified formulation | rotavirus, live, monovalent vaccine | 03/23/2010 | YES | Complete | ||
| influenza, unspecified formulation | Influenza, injectable,quadrivalent, preservative free, pediatric | 09/25/2010 | YES | Complete | ||
| influenza, unspecified formulation | Influenza, injectable,quadrivalent, preservative free, pediatric | 10/27/2010 | YES | Complete | ||
| influenza, unspecified formulation | Influenza, injectable,quadrivalent, preservative free, pediatric | 10/02/2011 | Complete | |||
| influenza, unspecified formulation | Influenza, injectable,quadrivalent, preservative free, pediatric | 04/04/2012 | Complete | |||
| Hep A, unspecified formulation | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | 11/23/2011 | Complete | |||
| Hep A, unspecified formulation | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | 05/23/2012 | Complete | |||
| MMRV | measles, mumps, rubella, and varicella virus vaccine | 10/23/2010 | NO | Early | Complete | |
| MMRV | measles, mumps, rubella, and varicella virus vaccine | 11/22/2012 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| IPV | 05/22/2010 | 05/22/2010 | 05/22/2011 | |||
| IPV | 11/22/2013 | 11/22/2013 | 11/22/2015 | |||
| influenza, unspecified formulation | 09/01/2015 | 09/01/2015 | 01/31/2016 | |||
| MMR | 11/22/2013 | 11/22/2013 | 11/22/2015 | |||
| Varicella | 11/22/2013 | 11/22/2013 | 11/22/2015 | |||
If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry) |
If the EMR already recognizes the dose as invalid, then this step may be skipped. |
MMRV status indicates that the first MMRV dose is valid. |
MMRV status for the first MMRV dose administered on 10/23/2010 is set to invalid. |
dose validity is an important aspect of: Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.
|
Vendor is able to record that the vaccination dose is invalid with a reason that it was given too early |
No Note |
The physician accesses the record for Juana Mariana Gonzales and: • Displays the registry forecast which includes the need for a second, valid MMRV vaccine and also the need for influenza and polio vaccines (since the registry has no information about them) |
No Comments |
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. |
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales) |
View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast. |
1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 2. Verify that All forecast vaccines and dates returned by the registry are displayed to the user. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Gonzales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Juana | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Acosta | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 200912231105 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 4345 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551212 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200911231105 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | .25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121104 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 9 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 10 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 11 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 12 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 13 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 14 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 15 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 16 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 17 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 18 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 19 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 20 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100323 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100323 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 26 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 27 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 28 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 29 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20110221 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20110221 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 30 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 31 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 32 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 33 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 34 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 35 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 36 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 37 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 38 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 39 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 40 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 41 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 42 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 43 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 44 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 45 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 46 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 47 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 48 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 49 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 50 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 51 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 52 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 53 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 54 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 55 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 56 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 57 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 58 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 59 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 60 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 61 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 62 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 63 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 64 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 65 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 67 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 68 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 69 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 70 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 71 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 72 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 73 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 78 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 79 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 80 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 81 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 82 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 83 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 84 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 85 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 86 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 87 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 88 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 89 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 90 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 91 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 92 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 93 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20111123 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20111123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 94 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 95 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20120523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20120523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 98 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 99 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | N | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 101 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30982-3 | |
| OBX.3.2 | Text | Reason code | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20101023 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20101023 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 102 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 103 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 104 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 105 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20121122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20121122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160131 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Juana Mariana Gonzales Display Reconcile Update Immunization Information | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 123456 | Juana Mariana Gonzales | 11/23/2009 | Female | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B Peds NOS | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | 11/23/2009 | YES | Complete | ||
| Hep B Peds NOS | hepatitis B vaccine, unspecified formulation | 01/15/2010 | YES | Complete | ||
| Hep B Peds NOS | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | 10/30/2010 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | 01/22/2010 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | 03/23/2010 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | 05/22/2010 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | 02/21/2011 | YES | Complete | ||
| Hib, unspecified formulation | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | 01/22/2010 | YES | Complete | ||
| Hib, unspecified formulation | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | 03/23/2010 | YES | Complete | ||
| Hib, unspecified formulation | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | 05/22/2010 | YES | Complete | ||
| Hib, unspecified formulation | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | 02/21/2011 | YES | Complete | ||
| poliovirus vaccine, inactivated | poliovirus vaccine, inactivated | 01/22/2010 | YES | Complete | ||
| poliovirus vaccine, inactivated | poliovirus vaccine, inactivated | 03/23/2010 | YES | Complete | ||
| pneumococcal, unspecified formulation | pneumococcal conjugate vaccine, 13 valent | 01/21/2010 | YES | Complete | ||
| pneumococcal, unspecified formulation | pneumococcal conjugate vaccine, 13 valent | 03/23/2010 | YES | Complete | ||
| pneumococcal, unspecified formulation | pneumococcal conjugate vaccine, 13 valent | 05/22/2010 | YES | Complete | ||
| pneumococcal, unspecified formulation | pneumococcal conjugate vaccine, 13 valent | 02/21/2011 | YES | Complete | ||
| rotavirus, unspecified formulation | rotavirus, live, monovalent vaccine | 01/22/2010 | YES | Complete | ||
| rotavirus, unspecified formulation | rotavirus, live, monovalent vaccine | 01/22/2010 | YES | Complete | ||
| influenza, unspecified formulation | Influenza, injectable,quadrivalent, preservative free, pediatric | 09/25/2010 | YES | Complete | ||
| influenza, unspecified formulation | Influenza, injectable,quadrivalent, preservative free, pediatric | 10/27/2010 | YES | Complete | ||
| influenza, unspecified formulation | Influenza, injectable,quadrivalent, preservative free, pediatric | 10/02/2011 | Complete | |||
| influenza, unspecified formulation | Influenza, injectable,quadrivalent, preservative free, pediatric | 11/04/2012 | Complete | |||
| Hep A, unspecified formulation | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | 11/23/2011 | Complete | |||
| Hep A, unspecified formulation | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | 05/23/2012 | Complete | |||
| MMRV | measles, mumps, rubella, and varicella virus vaccine | 10/23/2010 | NO | Early | Complete | |
| MMRV | measles, mumps, rubella, and varicella virus vaccine | 11/22/2012 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| IPV | 05/22/2010 | 05/22/2010 | 05/22/2011 | |||
| IPV | 11/22/2013 | 11/22/2013 | 11/22/2015 | |||
| influenza, unspecified formulation | 09/01/2015 | 09/01/2015 | 01/31/2016 | |||
| MMR | 11/22/2013 | 11/22/2013 | 11/22/2015 | |||
| Varicella | 11/22/2013 | 11/22/2013 | 11/22/2015 | |||
Juana Maria Gonzales Morales immunization registry provided Evaluated History and Forecast is reconciled with the Immunization history information in the EMR. |
No Comments |
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import. |
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales) |
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry. |
1. The user imports returned vaccinations as follows:
a. Vaccinations NOT imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 1/15/2010
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
VERIFY that the dose validity is marked as invalid
b. Vaccinations Imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 12/23/2009
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 10/30/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/23/2010,
Including adverse reaction 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/21/2011
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/23/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 2/21/2011
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2010
poliovirus vaccine, inactivated (CVX 10) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 2/21/2011
rotavirus, live, monovalent vaccine (CVX 119) administered 3/23/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/25/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/27/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/2/2011
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 11/4/2012
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 11/23/2011
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/23/2012
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
|
No Note |
Once the vaccine history is reconciled in the EMR, the vaccine forecast is updated. |
No Comments |
EMR Vaccine History is Reconciled with Immunization History from the IIS (previous step 'Reconcile and import vaccinations from Evaluated History and Forecast returned by the Registry for Juana Mariana Gonzales'). |
An updated vaccine forecast based upon the reconciled vaccine history is available to the user. |
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service. |
Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history: 1. Verify that the EMR does not include in reconciled vaccine forecast:
IPV due on 5/22/2010
2. Verify that the EMR includes in reconciled vaccine forecast:
IPV due on 11/22/2013
MMR due on 5/22/2011
Varicella due on 5/22/2011
influenza, unspecified formulation due on 10/21/2015
|
No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
|
The physician accesses the record for Juan Marcel Gonzales and: • Accepts the vaccines provided by the registry as this is a new patient and there are no prior vaccines recorded • Views the registry history including the second dose of Hepatitis B vaccine given late (at 2 years of age) and no history of a third dose; influenza vaccine was also not given since 2013 |
There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response. |
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.
|
|
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juan Marcel Gonzales) |
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry. |
1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 2. The user imports returned vaccinations as follows:a. Vaccinations Imported: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 11/23/2011
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 12/23/2013
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2012Verify that the EMR is alerted that this dose was given too late diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/22/2012
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/21/2012
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/20/2013
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2012
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/22/2012
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/21/2012
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 11/22/2012
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2012
poliovirus vaccine, inactivated (CVX 10) administered 3/22/2012
poliovirus vaccine, inactivated (CVX 10) administered 5/21/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2012pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/22/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/21/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 11/22/2012
rotavirus, live, monovalent vaccine (CVX 119) administered 1/22/2012
rotavirus, live, monovalent vaccine (CVX 119) administered 3/22/2012
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/22/2012Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/20/2012
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/30/2013
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/21/2013
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 12/1/2013
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
|
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Gonzales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Juan | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | Marcel | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Morales | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | L | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 201111231100 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 3321 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | 06903 | |
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551213 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juan | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Marcel | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 201111231100 | |
| PID.8 | Administrative Sex | M | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4623 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111223 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130220 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120512 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120222 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | Polio (IPV) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | Polio (IPV) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | Polio (IPV) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | Rotavirus | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 1.0 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | Rotavirus | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 1.0 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120922 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121022 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | Hepatitis A | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131201 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | Hepatitis A | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130112 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | MMR and Varicella | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Thigh Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 13 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 14 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 15 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 16 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 17 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 18 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 19 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 20 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 30 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 31 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 32 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 33 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 34 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 35 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 36 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 37 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 38 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 39 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 40 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 41 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 42 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 43 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 44 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 45 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 46 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | poliovirus vaccine, inactivated | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 47 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 48 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 49 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 50 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | poliovirus vaccine, inactivated | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 51 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 52 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 53 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 54 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 55 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 56 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 57 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 58 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 59 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 60 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 61 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 62 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 63 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 64 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 65 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 67 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 68 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 69 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 71 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 72 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 73 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 78 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 79 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 80 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 20 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 81 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 20 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 82 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 83 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 84 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 20 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 85 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 20 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 86 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 87 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 90 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 91 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 92 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 21 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 93 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 21 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 94 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 95 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 22 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 22 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 98 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 94 | |
| OBX.5.2 | Text | MMRV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 99 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 23 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 23 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 45 | |
| OBX.5.2 | Text | Hep B, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20120521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20120521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20130521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20130523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 24 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | DTaP, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171121 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 25 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | IPV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171121 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 26 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151022 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 03 | |
| OBX.5.2 | Text | MMR | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171121 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 27 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 21 | |
| OBX.5.2 | Text | Varicella | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 116 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171121 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Juan Marcel Gonzales Display Reconcile Update Immunization Information | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 123456 | Juan Marcel Gonzales | 11/23/2011 | Male | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B Peds NOS | Hepatitis B | 11/23/2011 | YES | Complete | ||
| Hep B Peds NOS | Hepatitis B | 12/23/2011 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | DTaP | 01/22/2012 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | DTaP | 03/22/2012 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | DTaP | 05/21/2012 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | DTaP | 02/20/2013 | YES | Complete | ||
| Hib, unspecified formulation | Hib | 01/22/2012 | YES | Complete | ||
| Hib, unspecified formulation | Hib | 03/22/2012 | YES | Complete | ||
| Hib, unspecified formulation | Hib | 05/12/2012 | YES | Complete | ||
| Hib, unspecified formulation | Hib | 02/22/2012 | YES | Complete | ||
| poliovirus vaccine, inactivated | Polio (IPV) | 01/22/2012 | YES | Complete | ||
| poliovirus vaccine, inactivated | Polio (IPV) | 03/22/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Polio (IPV) | 05/21/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Pneumococcal conjugate (PCV13) | 01/22/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Pneumococcal conjugate (PCV13) | 03/22/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Pneumococcal conjugate (PCV13) | 05/21/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Pneumococcal conjugate (PCV13) | 11/22/2012 | YES | Complete | ||
| rotavirus, unspecified formulation | Rotavirus | 11/22/2012 | YES | Complete | ||
| rotavirus, unspecified formulation | Rotavirus | 03/22/2012 | YES | Complete | ||
| influenza, unspecified formulation | Influenza | 09/22/2012 | YES | Complete | ||
| influenza, unspecified formulation | Influenza | 10/22/2012 | YES | Complete | ||
| influenza, unspecified formulation | Influenza | 10/30/2013 | Complete | |||
| Hep A, unspecified formulation | Hepatitis A | 05/21/2013 | Complete | |||
| Hep A, unspecified formulation | Hepatitis A | 12/01/2013 | Complete | |||
| MMRV | MMR and Varicella | 01/12/2013 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| Hep B, unspecified formulation | 05/21/2012 | 05/21/2012 | 05/21/2013 | |||
| DTaP, unspecified formulation | 11/22/2015 | 11/22/2015 | 11/21/2017 | |||
| IPV | 11/22/2015 | 11/22/2015 | 11/21/2017 | |||
| influenza, unspecified formulation | 10/22/2015 | 11/22/2015 | 11/21/2017 | |||
| MMR | 11/22/2015 | 11/22/2015 | 11/21/2017 | |||
| Varicella | 11/22/2015 | 11/22/2015 | 11/21/2017 | |||
|
The physician accesses the record for Juan Marcel Gonzales and: • Views the vaccine forecast provided by the Immunization Registry |
No Comments |
|
A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing |
The vaccine forecast from the Immunization Registry is available for viewing in the EMR. |
View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast. |
|
1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Gonzales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Juan | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | Marcel | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Morales | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | L | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 201111231100 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 3321 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | 06903 | |
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551213 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juan | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Marcel | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 201111231100 | |
| PID.8 | Administrative Sex | M | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4623 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111223 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130220 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120512 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120222 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | Polio (IPV) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | Polio (IPV) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | Polio (IPV) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | Rotavirus | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 1.0 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | Rotavirus | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 1.0 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120922 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121022 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | Hepatitis A | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131201 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | Hepatitis A | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130112 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | MMR and Varicella | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Thigh Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 13 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 14 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 15 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 16 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 17 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 18 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 19 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 20 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 30 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 31 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 32 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 33 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 34 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 35 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 36 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 37 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 38 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 39 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 40 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 41 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 42 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 43 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 44 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 45 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 46 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | poliovirus vaccine, inactivated | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 47 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 48 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 49 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 50 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | poliovirus vaccine, inactivated | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 51 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 52 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 53 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 54 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 55 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 56 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 57 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 58 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 59 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 60 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 61 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 62 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 63 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 64 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 65 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 67 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 68 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 69 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 71 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 72 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 73 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 78 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 79 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 80 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 20 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 81 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 20 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 82 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 83 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 84 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 20 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 85 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 20 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 86 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 87 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 90 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 91 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 92 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 21 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 93 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 21 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 94 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 95 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 22 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 22 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 98 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 94 | |
| OBX.5.2 | Text | MMRV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 99 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 23 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 23 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 45 | |
| OBX.5.2 | Text | Hep B, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20120521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20120521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20130521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20130523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 24 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | DTaP, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171121 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 25 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | IPV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171121 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 26 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151022 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 03 | |
| OBX.5.2 | Text | MMR | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171121 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 27 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 21 | |
| OBX.5.2 | Text | Varicella | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 116 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171121 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20171122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 28 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Juan Marcel Gonzales Display Reconcile Update Immunization Information | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 123456 | Juan Marcel Gonzales | 11/23/2011 | Male | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B Peds NOS | Hepatitis B | 11/23/2011 | YES | Complete | ||
| Hep B Peds NOS | Hepatitis B | 12/23/2011 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | DTaP | 01/22/2012 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | DTaP | 03/22/2012 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | DTaP | 05/21/2012 | YES | Complete | ||
| diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | DTaP | 02/20/2013 | YES | Complete | ||
| Hib, unspecified formulation | Hib | 01/22/2012 | YES | Complete | ||
| Hib, unspecified formulation | Hib | 03/22/2012 | YES | Complete | ||
| Hib, unspecified formulation | Hib | 05/12/2012 | YES | Complete | ||
| Hib, unspecified formulation | Hib | 02/22/2012 | YES | Complete | ||
| poliovirus vaccine, inactivated | Polio (IPV) | 01/22/2012 | YES | Complete | ||
| poliovirus vaccine, inactivated | Polio (IPV) | 03/22/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Polio (IPV) | 05/21/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Pneumococcal conjugate (PCV13) | 01/22/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Pneumococcal conjugate (PCV13) | 03/22/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Pneumococcal conjugate (PCV13) | 05/21/2012 | YES | Complete | ||
| pneumococcal, unspecified formulation | Pneumococcal conjugate (PCV13) | 11/22/2012 | YES | Complete | ||
| rotavirus, unspecified formulation | Rotavirus | 11/22/2012 | YES | Complete | ||
| rotavirus, unspecified formulation | Rotavirus | 03/22/2012 | YES | Complete | ||
| influenza, unspecified formulation | Influenza | 09/22/2012 | YES | Complete | ||
| influenza, unspecified formulation | Influenza | 10/22/2012 | YES | Complete | ||
| influenza, unspecified formulation | Influenza | 10/30/2013 | Complete | |||
| Hep A, unspecified formulation | Hepatitis A | 05/21/2013 | Complete | |||
| Hep A, unspecified formulation | Hepatitis A | 12/01/2013 | Complete | |||
| MMRV | MMR and Varicella | 01/12/2013 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| Hep B, unspecified formulation | 05/21/2012 | 05/21/2012 | 05/21/2013 | |||
| DTaP, unspecified formulation | 11/22/2015 | 11/22/2015 | 11/21/2017 | |||
| IPV | 11/22/2015 | 11/22/2015 | 11/21/2017 | |||
| influenza, unspecified formulation | 10/22/2015 | 11/22/2015 | 11/21/2017 | |||
| MMR | 11/22/2015 | 11/22/2015 | 11/21/2017 | |||
| Varicella | 11/22/2015 | 11/22/2015 | 11/21/2017 | |||
|
The physician accesses the record for Juan Marcel Gonzales and, once the vaccine history is reconciled in the EMR, the vaccine forecast is updated : • The provider views the updated vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods) |
The vaccine forecast may be imported from the Immunization Registry Vaccination History and Forecast (Z42) response, or it may be generated by EMR defined means. |
|
EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juan Marcel Gonzales) |
|
A vaccine forecast based upon the imported vaccine history is available to the user. |
|
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service. |
1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history: Hep B Peds NOS due on 5/21/2012
DTaP due on 11/22/2015 MMR due on 11/22/2015
Varicella due on 11/22/2015
influenza, unspecified formulation due on Oct 22, 2015 or later
|
No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
|
The physician accesses the record for Mariela Gonzales Morales and: • Accepts the single vaccine in the registry record into the EHR history |
|
There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response. |
|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import. |
|
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Mariela Gonzales Morales) |
|
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry. |
|
1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 2. The user imports returned vaccinations as follows:
a. Vaccinations Imported: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 3/30/2015 |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Gonzales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Mariela | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | ||
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Morales | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 201505301100 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 3321 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | 06903 | |
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551214 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Morales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Mariela | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Gonzales | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 201505301100 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Stamford Regional Hospital | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150530 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Pike | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Susan | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 45 | |
| OBX.5.2 | Text | Hep B, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150629 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150629 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150730 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | DTaP, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 08 | |
| OBX.5.2 | Text | Hib | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | IPV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 152 | |
| OBX.5.2 | Text | Pneumococcal Conjugate, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 21 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 201501126 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 201501126 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 23 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20170529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20170530 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 28 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 03 | |
| OBX.5.2 | Text | MMR | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160827 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160828 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 30 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 21 | |
| OBX.5.2 | Text | Varicella | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 116 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160827 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160828 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 31 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Mariela Gonzales Morales Display Reconcile Update Immunization Information | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 123456 | Mariela Gonzales Morales | 05/30/2015 | Female | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B Peds NOS | Hepatitis B | 05/30/2015 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| Hep B, unspecified formulation | 06/29/2015 | 06/29/2015 | 07/29/2015 | |||
| DTaP, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| Hib | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| IPV | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| Pneumococcal Conjugate, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| rotavirus, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| influenza, unspecified formulation | 01/12/2015 | 01/12/2015 | 05/29/2017 | |||
| Hep A, unspecified formulation | 05/29/2016 | 05/29/2016 | 05/29/2017 | |||
| MMR | 05/29/2016 | 05/29/2016 | 08/27/2016 | |||
| Varicella | 05/29/2016 | 05/29/2016 | 08/27/2016 | |||
|
The physician accesses the record for Mariela Gonzales Morales and: • Views the vaccine forecast provided by the Immunization Registry |
No Comments |
|
A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing |
|
The vaccine forecast from the Immunization Registry is available for viewing in the EMR. |
|
View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast. |
|
The EMR displays the information returned from the Immunization Registry according to the Juror Document. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Gonzales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Mariela | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | ||
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Morales | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 201505301100 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 3321 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | 06903 | |
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551214 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Morales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Mariela | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Gonzales | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 201505301100 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Stamford Regional Hospital | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150530 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Pike | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Susan | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150629 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150629 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150730 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 21 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 201501126 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 201501126 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 23 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20170529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20170530 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 28 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160827 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160828 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 30 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 116 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160827 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160828 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 31 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Mariela Gonzales Morales Display Reconcile Update Immunization Information | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 123456 | Mariela Gonzales Morales | 05/30/2015 | Female | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B Peds NOS | Hepatitis B | 05/30/2015 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| Hep B, unspecified formulation | 06/29/2015 | 06/29/2015 | 07/29/2015 | |||
| DTaP, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| Hib | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| IPV | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| Pneumococcal Conjugate, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| rotavirus, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| influenza, unspecified formulation | 01/12/2015 | 01/12/2015 | 05/29/2017 | |||
| Hep A, unspecified formulation | 05/29/2016 | 05/29/2016 | 05/29/2017 | |||
| MMR | 05/29/2016 | 05/29/2016 | 08/27/2016 | |||
| Varicella | 05/29/2016 | 05/29/2016 | 08/27/2016 | |||
|
The physician accesses the record for Mariela Gonzales Morales and: • Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods) |
No Comments |
|
EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Mariela Gonzales Morales) |
|
A vaccine forecast based upon the imported vaccine history is available to the user. |
|
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service. |
1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history: Hep B Peds NOS due on 6/29/2015
DTaP due on 7/29/2015 Hib due on 7/29/2015 Pneumococcal conjugate due on 7/29/2015
Rotavirus due on 7/29/2015 HepA due on 5/29/2016 MMR due on 5/29/2016 Varicella due on 5/29/2016
influenza, unspecified formulation due on Nov 26, 2015 or later |
No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
|
The physician accesses the record for Juana Maria Gonzales Morales and: • Accepts the single vaccine in the registry record into the EHR history |
|
There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response. |
|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import. |
|
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Maria Gonzales Morales) |
|
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry. |
|
1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 2. The user imports returned vaccinations as follows:
a. Vaccinations Imported: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 3/30/2015 |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z42 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Morales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Juana | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | Maria Gonzales | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Gonzales | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | F | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 053020151100 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 3321 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | 06903 | |
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551214 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | BG2 | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | ||
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 053020151115 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Stamford Regional Hospital | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150530 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Pike | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Susan | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 45 | |
| OBX.5.2 | Text | Hep B, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150629 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150629 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150730 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | DTaP, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 08 | |
| OBX.5.2 | Text | Hib | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | IPV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 152 | |
| OBX.5.2 | Text | Pneumococcal Conjugate, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 21 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 201501126 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 201501126 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 23 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20170529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20170530 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 28 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 03 | |
| OBX.5.2 | Text | MMR | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160827 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160828 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 30 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 21 | |
| OBX.5.2 | Text | Varicella | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 116 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160827 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160828 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 31 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Juana Maria Gonzales Morales Display Reconcile Update Immunization Information | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 123456 | BG2 Gonzales | 20/15/0530 | Female | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B Peds NOS | Hepatitis B | 05/30/2015 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| Hep B, unspecified formulation | 06/29/2015 | 06/29/2015 | 07/29/2015 | |||
| DTaP, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| Hib | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| IPV | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| Pneumococcal Conjugate, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| rotavirus, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| influenza, unspecified formulation | 01/12/2015 | 01/12/2015 | 05/29/2017 | |||
| Hep A, unspecified formulation | 05/29/2016 | 05/29/2016 | 05/29/2017 | |||
| MMR | 05/29/2016 | 05/29/2016 | 08/27/2016 | |||
| Varicella | 05/29/2016 | 05/29/2016 | 08/27/2016 | |||
|
The physician accesses the record for Juana Maria Gonzales Morales and: • Views the vaccine forecast provided by the Immunization Registry |
No Comments |
|
A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing |
|
The vaccine forecast from the Immunization Registry is available for viewing in the EMR. |
|
View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast. |
|
1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z42 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Morales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Juana | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | Maria Gonzales | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Gonzales | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | F | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 053020151100 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 3321 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | 06903 | |
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551214 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | BG2 | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | ||
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 053020151115 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Stamford Regional Hospital | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150530 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Pike | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Susan | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150601 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150629 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150629 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150730 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150729 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 21 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 201501126 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 201501126 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 23 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20170529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20170530 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 28 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160827 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160828 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 30 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 116 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160529 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160827 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160828 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 31 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Juana Maria Gonzales Morales Display Reconcile Update Immunization Information | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 123456 | BG2 Gonzales | 20/15/0530 | Female | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B Peds NOS | Hepatitis B | 05/30/2015 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| Hep B, unspecified formulation | 06/29/2015 | 06/29/2015 | 07/29/2015 | |||
| DTaP, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| Hib | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| IPV | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| Pneumococcal Conjugate, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| rotavirus, unspecified formulation | 07/29/2015 | 07/29/2015 | 05/29/2017 | |||
| influenza, unspecified formulation | 01/12/2015 | 01/12/2015 | 05/29/2017 | |||
| Hep A, unspecified formulation | 05/29/2016 | 05/29/2016 | 05/29/2017 | |||
| MMR | 05/29/2016 | 05/29/2016 | 08/27/2016 | |||
| Varicella | 05/29/2016 | 05/29/2016 | 08/27/2016 | |||
|
The physician accesses the record for Juana Maria Gonzales Morales and: • Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods) |
No Comments |
|
EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juana Maria Gonzales Morales) |
|
A vaccine forecast based upon the imported vaccine history is available to the user. |
|
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service. |
1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history: Hep B Peds NOS due on 6/29/2015
DTaP due on 7/29/2015 Hib due on 7/29/2015 Pneumococcal conjugate due on 7/29/2015
Rotavirus due on 7/29/2015 HepA due on 5/29/2016 MMR due on 5/29/2016 Varicella due on 5/29/2016
|
No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
|
The physician accesses the record for Juana Mariana Gonzales and: • Selects order for IPV and views information about the prior febrile seizure post-IPV vaccine |
No Comments |
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. |
IPV order entered in patient record. User notified of history of adverse reaction to IPV (febrile seizures). |
Notify of Previous Adverse Event: EHRs and other clinical software systems alert providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record. |
EMR Records the following order information and Alert:
|
No Note |
|
The mother is concerned about administering the IPV due to the prior adverse reaction, and refuses to have the child immunized for IPV. The provider documents mother’s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent. |
No Comments |
Prior Immunization History loaded and reconciled from the Immunization Registry. Order is attempted for IPV. Provider has been alerted to prior adverse reaction to IPV of febrile seizures. |
Vaccine non-administration due to parental refusal is documented in the patient record. Deferral is permanent. |
Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed. |
EMR documents the non-administration of the IPV due to the parental refulsal:
|
No Note |
|
The provider orders inactivated influenza vaccine and is notified that the patient as allergy to egg albumin |
No Comments |
|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. |
|
Intranasal form of the Influenza vaccine is ordered for the patient. |
|
Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s active allergies. |
EMR Records the following order information and Alert:
Provider changes the order to modifies the Vaccine type:
|
No Note |
As indicated by the vaccine forecast, the first MMRV administered was invalid as it was administered too soon. The provider orders MMRV as a catch-up dose. |
No Comments |
|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. |
MMRV vaccine is ordered for the patient. |
|
Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines. |
EMR Records the following order information and Alert:
|
No Note |
The nurse documents administration route for the nasal live, attenuated influenza vaccine |
This step covers data quality checking as an informative aspect of vaccine administration |
Order is placed for nasal live, attenuated influenza vaccine. |
The nasal live, attenuated influenza vaccination route has failed to be recorded as intramuscular in the EMR. |
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size. |
The EMR prevents the user for entering 'Intramuscular' as a route for the the nasal live, attenuated influenza vaccine. |
No Note |
|
The nurse administers the the nasal live, attenuated influenza vaccine
|
No Comments |
|
Order is placed for nasal live, attenuated influenza vaccine. |
|
The nasal live, attenuated influenza vaccinations is recorded in the EMR. |
|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size. |
EMR Records the following vaccine administration information:
|
No Note |
The nurse documents administration route for the MMRV vaccine |
This step covers data quality checking as an informative aspect of vaccine administration |
Order is placed for MMRV vaccine. |
The MMRV vaccination route has failed to be recorded as 'oral' in the EMR. |
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size. |
The EMR prevents the user for entering 'Oral' as a route for the the MMRV vaccine. |
No Note |
|
The nurse administers the the MMRV vaccine
|
No Comments |
|
Order is placed for MMRV vaccine. |
|
The MMRV vaccination is recorded in the EMR. |
|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size. |
EMR Records the following vaccine administration information:
|
No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
|
The physician accesses the record for Juan Marcel Gonzales and: • Orders administration of Influenza vaccine (intranasal, live virus vaccine) • Receives notification the patient has asthma, a relative contraindication for intranasal influenza vaccine |
No Comments |
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. |
User notified of history of contraindication tto nfluenza virus vaccine, live, attenuated, for intranasal use (CVX 111) |
Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s current or historical diagnoses. |
EMR Records the following order information and Alert:
The Provider changes the order to:
|
No Note |
As indicated by the vaccine forecast, the third Hepatitis B is overdue, and is ordered. |
No Comments |
|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. Vaccine forecast reviewed. |
Hepatitis B vaccine is ordered for the patient. |
|
Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines. |
EMR Records the following order information and Alert:
|
No Note |
The fifth DTaP is ordered, and the provider is notified that the dose is too early. |
No Comments |
|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. Vaccine forecast is available in the EMR. |
DTaP vaccine is ordered for the patient, and provider is notified that the dose is too early. |
|
Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required. Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines. |
EMR Records the following order information and Alert:
|
No Note |
The nurse documents administration lot number for the Hepatitis B vaccine |
Order is placed for Hepatitis B vaccine. |
The provider has been notified of the expired Hepatitis B vaccination lot. Documentation of a lot to be administered that is not expired is recorded in the EMR. |
Notify of Vaccine Dose Expiration: The EHR or other clinical software system notifies the provider administering a vaccine if the dose chosen for administration is expired. |
|
EMR Records the following order information and Alert:
|
No Note |
|
The nurse administers the the Hepatitis B vaccine
|
No Comments |
|
Order is placed for Hepatitis B vaccine. |
|
The Hepatitis B vaccination is recorded in the EMR. |
|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size. |
EMR Records the following vaccine administration information:
|
No Note |
The nurse documents administration for the inactivated influenza vaccine from a VFC source |
This step covers data quality checking as an informative aspect of vaccine administration |
Order is placed for inactivated influenza vaccine. |
The user is notified of vaccine dose ineligibility. |
Notify of Vaccine Dose Ineligibility: The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected. |
The provider documents a VFC lot to be administered in the EMR. Once notified that the patient is not eligible for the VFC, the a non-VFC lot is selected.
The Provider selects a non-VFC Lot:
|
No Note |
|
The nurse administers the inactivated influenza vaccine
|
No Comments |
|
Order is placed for inactivated influenza vaccine. |
|
The inactivated influenza vaccine administration is recorded in the EMR. |
|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size. |
EMR Records the following vaccine administration information:
|
No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
The physician accesses the record for Mariela Gonzales Morales and: |
No Comment |
|
Prior Immunization History loaded and reconciled from the Immunization Registry. Vaccine forecast is available in the EMR indicating 5 vaccines are due: Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus |
Vaccine deferral is recorded indicating the medical reason of low grade fever |
Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed. |
EMR Records the following vaccine administration information:
|
No Note |
| Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS. |
| The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS. |
| The vaccines for the visit have been administered. |
| No PostCondition |
| Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries. |
| No evaluation criteria |
| No Note |
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS. |
The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS. |
The vaccines for the visit have been administered. |
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries. |
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | Test EHR Application | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | X68 | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | NIST Test Iz Reg | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20120701082240-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | NIST-IZ-001.00 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | Test Case Fixed |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | Test Case Fixed |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | Test Case Fixed |
| PID.5.7 | Name Type Code | L | Test Case Fixed |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Acosta | Test Case Fixed |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | Test Case Fixed |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200911231105 | Test Case Fixed |
| PID.8 | Administrative Sex | F | Test Case Fixed |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | Test Case Fixed |
| PID.10.2 | Text | White | Test Case Fixed |
| PID.10.3 | Name of Coding System | HL70005 | Test Case Fixed |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | Test Case Fixed |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| PID.11.6 | Country | USA | Test Case Fixed |
| PID.11.7 | Address Type | L | Test Case Fixed |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 325 Shorline Drive | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06901 | |
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | BDL | Test Case Fixed |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| PID.13.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 203 | Test Case Fixed |
| PID.13.7 | Local Number | 5551212 | Test Case Fixed |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | Test Case Fixed |
| PID.22.2 | Text | Hispanic or Latino | Test Case Fixed |
| PID.22.3 | Name of Coding System | CDCREC | Test Case Fixed |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | ||
| PID.25 | Birth Order | ||
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/Recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | ||
| PD1.13 | Protection Indicator Effective Date | ||
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20120701 | |
| PD1.18 | Publicity Code Effective Date | 20120701 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Gonzales | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Joanna | Test Case Fixed |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Merida | Test Case Fixed |
| NK1.2.7 | Name Type Code | L | Test Case Fixed |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | GRP | Test Case Fixed |
| NK1.3.2 | Text | Grandparent | Test Case Fixed |
| NK1.3.3 | Name of Coding System | HL70063 | Test Case Fixed |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Stamford | Test Case Fixed |
| NK1.4.4 | State or Province | CT | Test Case Fixed |
| NK1.4.5 | Zip or Postal Code | 06901 | Test Case Fixed |
| NK1.4.6 | Country | ||
| NK1.4.7 | Address Type | L | Test Case Fixed |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| NK1.5.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 203 | Test Case Fixed |
| NK1.5.7 | Local Number | 5551212 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Sirtis | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lisa | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Carter | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Jane | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SH | |
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Ricci | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Gina | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Sirtis | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lisa | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6332FK33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101214 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Immunization | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK1 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101001 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK24 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120831 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2341 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20111130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2433 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110904 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS3255 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101201 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS249 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110301 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20140831 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D643QS8243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140901 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M54K9245 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100324 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M55K3342 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101030 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M75K4566 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100523 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M53K5534 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV2431 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101004 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV4344 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100323 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D335PV9644 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150519 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | 00 | |
| RXA.18.2 | Text | Parental decision | |
| RXA.18.3 | Name of Coding System | NIP002 | |
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | RE | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P243V3281 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P343V8321 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100330 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V2164 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100830 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V58532 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110418 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV533 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV932 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100510 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9334IN9333 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120522 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 03 | |
| RXA.9.2 | Text | Historical information - from parents written record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Ricci | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Gina | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3423 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140701 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | |
| RXA.17.2 | Text | MedImmune, LLC | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | Test Case Fixed |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | Test Case Fixed |
| RXA.5.6 | Name of Alternate Coding System | NDC | Test Case Fixed |
| RXA.6 | Administered Amount | 0.2 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | Test Case Fixed |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | Test Case Fixed |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | Test Case Fixed |
| RXA.9.2 | Text | New immunization record | Test Case Fixed |
| RXA.9.3 | Name of Coding System | NIP001 | Test Case Fixed |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | Test Case Fixed |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | Test Case Fixed |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3521 | Test Case Fixed |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150815 | Test Case Fixed |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | Test Case Fixed |
| RXA.17.2 | Text | MedImmune,LLC | Test Case Fixed |
| RXA.17.3 | Name of Coding System | MVX | Test Case Fixed |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121104 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9553IN2243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120430 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120124 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT48 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120911 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W27V7491 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3452 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130413 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | Test Case Fixed |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ProQuad | Test Case Fixed |
| RXA.5.6 | Name of Alternate Coding System | NDC | Test Case Fixed |
| RXA.6 | Administered Amount | 0.5 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | Test Case Fixed |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | Test Case Fixed |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | Test Case Fixed |
| RXA.9.2 | Text | New immunization record | Test Case Fixed |
| RXA.9.3 | Name of Coding System | NIP001 | Test Case Fixed |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | Test Case Fixed |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | Test Case Fixed |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3687 | Test Case Fixed |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150715 | Test Case Fixed |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | Test Case Fixed |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | Test Case Fixed |
| RXA.17.3 | Name of Coding System | MVX | Test Case Fixed |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | |
| RXR.1.2 | Text | Nasal | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Nasal | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | Test Case Fixed |
| RXR.1.2 | Text | Nasal | Test Case Fixed |
| RXR.1.3 | Name of Coding System | NCIT | Test Case Fixed |
| RXR.1.5 | Alternate Text | Nasal | Test Case Fixed |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | Test Case Fixed |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | Test Case Fixed |
| RXR.1.2 | Text | Subcutaneous | Test Case Fixed |
| RXR.1.3 | Name of Coding System | NCIT | Test Case Fixed |
| RXR.1.5 | Alternate Text | Subcutaneous | Test Case Fixed |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | Test Case Fixed |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | Test Case Fixed |
| RXR.2.2 | Text | Left Deltoid | Test Case Fixed |
| RXR.2.3 | Name of Coding System | HL70163 | Test Case Fixed |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC12 | |
| OBX.5.2 | Text | fever of >40.5C (105F) within 48 hours of dose | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | Test Case Fixed |
| OBX.3.2 | Text | VIS Publication Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20140819 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | Test Case Fixed |
| OBX.3.2 | Text | VIS Presentation Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | Test Case Fixed |
| OBX.3.2 | Text | vaccine fund pgm elig cat | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC elig | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | Test Case Fixed |
| OBX.3.2 | Text | VIS Publication Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | Test Case Fixed |
| OBX.3.2 | Text | VIS Presentation Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | Test Case Fixed |
| OBX.3.2 | Text | vaccine fund pgm elig cat | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC elig | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Juana Mariana Gonzales |
| Mother's Maiden Name | Maria Acosta |
| ID Number | 123456 987633 |
| Date/Time of Birth | 11/23/2009 |
| Administrative Sex | Female |
| Patient Address | 4345 Standish Way Stamford CT 06903 USA |
| Patient Address 1 | 325 Shorline Drive Stamford CT 06901 |
| Local Number | (203)555-1212 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 07/01/2012 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 07/01/2012 |
| Protection Indicator | |
| Protection Indicator Effective Date |
| Element | Data |
|---|---|
| Name | Joanna Merida Gonzales |
| Relationship | Grandparent |
| Address | 4345 Standish Way Stamford CT 06901 |
| Phone Number | (203)555-1212 |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 11/23/2009 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Lisa Sirtis |
| Substance Lot Number | 6332FK33 |
| Substance Expiration Date | 12/14/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, unspecified formulation |
| Date/Time Start of Administration | 01/15/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Immunization |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6352FK1 |
| Substance Expiration Date | 10/01/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 10/30/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6352FK24 |
| Substance Expiration Date | 08/31/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2341 |
| Substance Expiration Date | 11/30/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2433 |
| Substance Expiration Date | 09/04/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS3255 |
| Substance Expiration Date | 12/01/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Reaction | fever of >40.5C (105F) within 48 hours of dose |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS249 |
| Substance Expiration Date | 03/01/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 08/31/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D643QS8243 |
| Substance Expiration Date | 09/01/2014 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M54K9245 |
| Substance Expiration Date | 03/24/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M55K3342 |
| Substance Expiration Date | 10/30/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M75K4566 |
| Substance Expiration Date | 05/23/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M53K5534 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV2431 |
| Substance Expiration Date | 10/04/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV4344 |
| Substance Expiration Date | 03/23/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D335PV9644 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 05/19/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 01/21/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P243V3281 |
| Substance Expiration Date | 01/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P343V8321 |
| Substance Expiration Date | 03/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V2164 |
| Substance Expiration Date | 08/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V58532 |
| Substance Expiration Date | 04/18/2011 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV533 |
| Substance Expiration Date | 02/15/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV932 |
| Substance Expiration Date | 05/10/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 09/25/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/27/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/02/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9334IN9333 |
| Substance Expiration Date | 05/22/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/15/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from parents written record |
| Administering Provider | Gina Ricci |
| Substance Lot Number | 8L4B3423 |
| Substance Expiration Date | 07/01/2014 |
| Substance Manufacturer Name | MedImmune, LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Gina Ricci |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.2 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 8L4B3521 |
| Substance Expiration Date | 08/15/2015 |
| Substance Manufacturer Name | MedImmune,LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 08/19/2014 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 11/04/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9553IN2243 |
| Substance Expiration Date | 04/30/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 11/23/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT33 |
| Substance Expiration Date | 01/24/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 05/23/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT48 |
| Substance Expiration Date | 09/11/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 10/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | historical |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W27V7491 |
| Substance Expiration Date | 12/15/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 11/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W87V3452 |
| Substance Expiration Date | 04/13/2013 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 7W87V3687 |
| Substance Expiration Date | 07/15/2015 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 05/21/2010 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
Following the vaccine administration, the patient's mother reports that the patient that evening had persistent, inconsolable crying lasting > 3 hours. |
No Comments |
The vaccinations for the visit have been administered. |
The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR. |
Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events. |
Verify that vendor can record the adverse reaction of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose correctly and without omission |
No Note |
The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is reported to the Immunization Registry using a Z22/VXU message. |
No Comments |
An adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR. |
The adverse reaction has been transmitted to the IIS. |
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries. |
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | Test EHR Application | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | X68 | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | NIST Test Iz Reg | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20120701082240-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | NIST-IZ-001.00 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | Test Case Fixed |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | Test Case Fixed |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | Test Case Fixed |
| PID.5.7 | Name Type Code | L | Test Case Fixed |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Acosta | Test Case Fixed |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | Test Case Fixed |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200912231105 | Test Case Fixed |
| PID.8 | Administrative Sex | F | Test Case Fixed |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | Test Case Fixed |
| PID.10.2 | Text | White | Test Case Fixed |
| PID.10.3 | Name of Coding System | HL70005 | Test Case Fixed |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | Test Case Fixed |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| PID.11.6 | Country | USA | Test Case Fixed |
| PID.11.7 | Address Type | L | Test Case Fixed |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 325 Shorline Drive | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06901 | |
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | BDL | Test Case Fixed |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| PID.13.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 203 | Test Case Fixed |
| PID.13.7 | Local Number | 5551212 | Test Case Fixed |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | Test Case Fixed |
| PID.22.2 | Text | Hispanic or Latino | Test Case Fixed |
| PID.22.3 | Name of Coding System | CDCREC | Test Case Fixed |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | ||
| PID.25 | Birth Order | ||
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/Recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | ||
| PD1.13 | Protection Indicator Effective Date | ||
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20120701 | |
| PD1.18 | Publicity Code Effective Date | 20120701 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Gonzales | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Joanna | Test Case Fixed |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Merida | Test Case Fixed |
| NK1.2.7 | Name Type Code | L | Test Case Fixed |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | GRP | Test Case Fixed |
| NK1.3.2 | Text | Grandparent | Test Case Fixed |
| NK1.3.3 | Name of Coding System | HL70063 | Test Case Fixed |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Stamford | Test Case Fixed |
| NK1.4.4 | State or Province | CT | Test Case Fixed |
| NK1.4.5 | Zip or Postal Code | 06901 | Test Case Fixed |
| NK1.4.6 | Country | ||
| NK1.4.7 | Address Type | L | Test Case Fixed |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| NK1.5.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 203 | Test Case Fixed |
| NK1.5.7 | Local Number | 5551212 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Sirtis | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lisa | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Carter | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Jane | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SH | |
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Ricci | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Gina | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Sirtis | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lisa | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6332FK33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101214 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Immunization | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK1 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101001 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK24 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120831 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2341 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20111130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2433 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110904 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS3255 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101201 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS249 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110301 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20140831 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D643QS8243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140901 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M54K9245 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100324 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M55K3342 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101030 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M75K4566 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100523 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M53K5534 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV2431 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101004 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV4344 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100323 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D335PV9644 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150519 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | 00 | |
| RXA.18.2 | Text | Parental decision | |
| RXA.18.3 | Name of Coding System | NIP002 | |
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | RE | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P243V3281 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P343V8321 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100330 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V2164 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100830 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V58532 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110418 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV533 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV932 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100510 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9334IN9333 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120522 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 03 | |
| RXA.9.2 | Text | Historical information - from parents written record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Ricci | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Gina | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3423 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140701 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | |
| RXA.17.2 | Text | MedImmune, LLC | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.2 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3521 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150815 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | |
| RXA.17.2 | Text | MedImmune,LLC | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121104 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9553IN2243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120430 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120124 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT48 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120911 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W27V7491 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3452 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130413 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | Test Case Fixed |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ProQuad | Test Case Fixed |
| RXA.5.6 | Name of Alternate Coding System | NDC | Test Case Fixed |
| RXA.6 | Administered Amount | 0.5 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | Test Case Fixed |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | Test Case Fixed |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | Test Case Fixed |
| RXA.9.2 | Text | New immunization record | Test Case Fixed |
| RXA.9.3 | Name of Coding System | NIP001 | Test Case Fixed |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | Test Case Fixed |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | Test Case Fixed |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3687 | Test Case Fixed |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150715 | Test Case Fixed |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | Test Case Fixed |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | Test Case Fixed |
| RXA.17.3 | Name of Coding System | MVX | Test Case Fixed |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | |
| RXR.1.2 | Text | Nasal | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Nasal | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | |
| RXR.1.2 | Text | Nasal | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Nasal | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | Test Case Fixed |
| RXR.1.2 | Text | Subcutaneous | Test Case Fixed |
| RXR.1.3 | Name of Coding System | NCIT | Test Case Fixed |
| RXR.1.5 | Alternate Text | Subcutaneous | Test Case Fixed |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | Test Case Fixed |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | Test Case Fixed |
| RXR.2.2 | Text | Left Deltoid | Test Case Fixed |
| RXR.2.3 | Name of Coding System | HL70163 | Test Case Fixed |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC12 | |
| OBX.5.2 | Text | fever of >40.5C (105F) within 48 hours of dose | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20140819 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS Presentation Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC elig | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS Presentation Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC elig | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC elig | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | Test Case Fixed |
| OBX.3.2 | Text | Reaction | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC9 | |
| OBX.5.2 | Text | persistent, inconsolable crying lasting > 3 hours within 48 hours of dose | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Juana Mariana Gonzales |
| Mother's Maiden Name | Maria Acosta |
| ID Number | 123456 987633 |
| Date/Time of Birth | 12/23/2009 |
| Administrative Sex | Female |
| Patient Address | 4345 Standish Way Stamford CT 06903 USA |
| Patient Address 1 | 325 Shorline Drive Stamford CT 06901 |
| Local Number | (203)555-1212 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 07/01/2012 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 07/01/2012 |
| Protection Indicator | |
| Protection Indicator Effective Date |
| Element | Data |
|---|---|
| Name | Joanna Merida Gonzales |
| Relationship | Grandparent |
| Address | 4345 Standish Way Stamford CT 06901 |
| Phone Number | (203)555-1212 |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 11/23/2009 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Lisa Sirtis |
| Substance Lot Number | 6332FK33 |
| Substance Expiration Date | 12/14/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, unspecified formulation |
| Date/Time Start of Administration | 01/15/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Immunization |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6352FK1 |
| Substance Expiration Date | 10/01/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 10/30/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6352FK24 |
| Substance Expiration Date | 08/31/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2341 |
| Substance Expiration Date | 11/30/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2433 |
| Substance Expiration Date | 09/04/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS3255 |
| Substance Expiration Date | 12/01/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Reaction | fever of >40.5C (105F) within 48 hours of dose |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS249 |
| Substance Expiration Date | 03/01/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 08/31/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D643QS8243 |
| Substance Expiration Date | 09/01/2014 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M54K9245 |
| Substance Expiration Date | 03/24/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M55K3342 |
| Substance Expiration Date | 10/30/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M75K4566 |
| Substance Expiration Date | 05/23/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M53K5534 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV2431 |
| Substance Expiration Date | 10/04/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV4344 |
| Substance Expiration Date | 03/23/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D335PV9644 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 05/19/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 01/21/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P243V3281 |
| Substance Expiration Date | 01/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P343V8321 |
| Substance Expiration Date | 03/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V2164 |
| Substance Expiration Date | 08/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V58532 |
| Substance Expiration Date | 04/18/2011 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV533 |
| Substance Expiration Date | 02/15/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV932 |
| Substance Expiration Date | 05/10/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 09/25/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/27/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/02/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9334IN9333 |
| Substance Expiration Date | 05/22/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/15/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from parents written record |
| Administering Provider | Gina Ricci |
| Substance Lot Number | 8L4B3423 |
| Substance Expiration Date | 07/01/2014 |
| Substance Manufacturer Name | MedImmune, LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Gina Ricci |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.2 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 8L4B3521 |
| Substance Expiration Date | 08/15/2015 |
| Substance Manufacturer Name | MedImmune,LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 08/19/2014 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 11/04/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9553IN2243 |
| Substance Expiration Date | 04/30/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 11/23/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT33 |
| Substance Expiration Date | 01/24/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 05/23/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT48 |
| Substance Expiration Date | 09/11/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 10/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | historical |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W27V7491 |
| Substance Expiration Date | 12/15/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 11/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W87V3452 |
| Substance Expiration Date | 04/13/2013 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 7W87V3687 |
| Substance Expiration Date | 07/15/2015 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 05/21/2010 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| vaccine fund pgm elig cat | Not VFC elig |
| Reaction | persistent, inconsolable crying lasting > 3 hours within 48 hours of dose |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report MAY send the immunizations that the EMR imported from the IIS. |
The Report must include all newly administered vaccines in any order. The report may include the information imported from the IIS. |
The vaccines for the visit have been administered. |
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries. |
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | Test EHR Application | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | X68 | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | NIST Test Iz Reg | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20120701082240-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | NIST-IZ-001.00 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juan | Test Case Fixed |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Marcel | Test Case Fixed |
| PID.5.7 | Name Type Code | L | Test Case Fixed |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Morales | Test Case Fixed |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | Test Case Fixed |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 201111231100 | Test Case Fixed |
| PID.8 | Administrative Sex | M | Test Case Fixed |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | Test Case Fixed |
| PID.10.2 | Text | White | Test Case Fixed |
| PID.10.3 | Name of Coding System | HL70005 | Test Case Fixed |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4623 Standish Way | Test Case Fixed |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | Test Case Fixed |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| PID.11.6 | Country | USA | Test Case Fixed |
| PID.11.7 | Address Type | L | Test Case Fixed |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| PID.13.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 203 | Test Case Fixed |
| PID.13.7 | Local Number | 5551213 | Test Case Fixed |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | Test Case Fixed |
| PID.22.2 | Text | Hispanic or Latino | Test Case Fixed |
| PID.22.3 | Name of Coding System | CDCREC | Test Case Fixed |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | ||
| PID.25 | Birth Order | ||
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/Recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | ||
| PD1.13 | Protection Indicator Effective Date | ||
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20120701 | |
| PD1.18 | Publicity Code Effective Date | 20120701 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Gonzales | Test Case Fixed |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Manuel | Test Case Fixed |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Marcel | Test Case Fixed |
| NK1.2.7 | Name Type Code | L | Test Case Fixed |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | FTH | Test Case Fixed |
| NK1.3.2 | Text | Father | Test Case Fixed |
| NK1.3.3 | Name of Coding System | HL70063 | Test Case Fixed |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 4623 Standish Way | Test Case Fixed |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Stamford | Test Case Fixed |
| NK1.4.4 | State or Province | CT | Test Case Fixed |
| NK1.4.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| NK1.4.6 | Country | ||
| NK1.4.7 | Address Type | L | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| NK1.5.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 203 | Test Case Fixed |
| NK1.5.7 | Local Number | 5551213 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Sirtis | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lisa | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Carter | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Jane | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SH | |
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J. | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J. | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6332FK34 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20111214 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111223 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK2 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20111001 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | Hepatitis B | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6332FK26 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150825 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2342 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20121130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2434 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120904 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS250 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140103 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130220 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | DTaP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS250 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140103 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M54K9255 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120324 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp and Dohme Corp. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M55K3343 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20121030 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp and Dohme Corp. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120512 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M75K4577 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120523 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp and Dohme Corp. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120222 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Hib | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M53K5535 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp and Dohme Corp. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | Polio (IPV) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV2444 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120410 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | MSanofi Pasteur Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | Polio (IPV) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV4343 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120323 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | MSanofi Pasteur Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | Polio (IPV) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV4343 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120323 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | MSanofi Pasteur Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P243V3321 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P343V8445 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120330 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V2175 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120830 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | Pneumococcal conjugate (PCV13) | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V58544 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130118 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | Rotavirus | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV543 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120322 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | Rotavirus | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV933 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120510 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120922 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8738 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121022 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8798 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9334IN9433 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140522 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8855 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150828 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130521 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | Hepatitis A | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT35 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140104 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131201 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | Hepatitis A | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT47 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130911 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130112 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | MMR and Varicella | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J. | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W27V7632 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20161215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp and Dohme Corp. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Thigh Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | SC | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20120202 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS Presentation Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20140819 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS Presentation Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Juan Marcel Gonzales |
| Mother's Maiden Name | Anita Morales |
| ID Number | 123456 987633 |
| Date/Time of Birth | 11/23/2011 |
| Administrative Sex | Male |
| Patient Address | 4623 Standish Way Stamford CT 06903 USA |
| Local Number | (203)555-1213 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 07/01/2012 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 07/01/2012 |
| Protection Indicator | |
| Protection Indicator Effective Date |
| Element | Data |
|---|---|
| Name | Manuel Marcel Gonzales |
| Relationship | Father |
| Address | 4623 Standish Way Stamford CT 06903 |
| Phone Number | (203)555-1213 |
| Element | Data |
|---|---|
| Administered Code | Hepatitis B |
| Date/Time Start of Administration | 11/23/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6332FK34 |
| Substance Expiration Date | 12/14/2011 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Code | Hepatitis B |
| Date/Time Start of Administration | 12/23/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6352FK2 |
| Substance Expiration Date | 10/01/2011 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Hepatitis B |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6332FK26 |
| Substance Expiration Date | 08/25/2015 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 02/02/2012 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| Element | Data |
|---|---|
| Administered Code | DTaP |
| Date/Time Start of Administration | 01/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D409QS2342 |
| Substance Expiration Date | 11/30/2012 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | DTaP |
| Date/Time Start of Administration | 03/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D409QS2434 |
| Substance Expiration Date | 09/04/2012 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | DTaP |
| Date/Time Start of Administration | 05/21/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D409QS250 |
| Substance Expiration Date | 01/03/2014 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | DTaP |
| Date/Time Start of Administration | 02/20/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D409QS250 |
| Substance Expiration Date | 01/03/2014 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Hib |
| Date/Time Start of Administration | 01/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7M54K9255 |
| Substance Expiration Date | 03/24/2012 |
| Substance Manufacturer Name | Merck Sharp and Dohme Corp. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Hib |
| Date/Time Start of Administration | 03/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7M55K3343 |
| Substance Expiration Date | 10/30/2012 |
| Substance Manufacturer Name | Merck Sharp and Dohme Corp. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Hib |
| Date/Time Start of Administration | 05/12/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7M75K4577 |
| Substance Expiration Date | 05/23/2012 |
| Substance Manufacturer Name | Merck Sharp and Dohme Corp. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Hib |
| Date/Time Start of Administration | 02/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7M53K5535 |
| Substance Expiration Date | 02/22/2012 |
| Substance Manufacturer Name | Merck Sharp and Dohme Corp. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Polio (IPV) |
| Date/Time Start of Administration | 01/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D333PV2444 |
| Substance Expiration Date | 04/10/2012 |
| Substance Manufacturer Name | MSanofi Pasteur Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Polio (IPV) |
| Date/Time Start of Administration | 03/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D333PV4343 |
| Substance Expiration Date | 03/23/2012 |
| Substance Manufacturer Name | MSanofi Pasteur Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Polio (IPV) |
| Date/Time Start of Administration | 05/21/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D333PV4343 |
| Substance Expiration Date | 03/23/2012 |
| Substance Manufacturer Name | MSanofi Pasteur Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Pneumococcal conjugate (PCV13) |
| Date/Time Start of Administration | 01/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | P243V3321 |
| Substance Expiration Date | 01/30/2012 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Pneumococcal conjugate (PCV13) |
| Date/Time Start of Administration | 03/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | P343V8445 |
| Substance Expiration Date | 03/30/2012 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Pneumococcal conjugate (PCV13) |
| Date/Time Start of Administration | 05/21/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | P853V2175 |
| Substance Expiration Date | 08/30/2012 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Pneumococcal conjugate (PCV13) |
| Date/Time Start of Administration | 11/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | P853V58544 |
| Substance Expiration Date | 01/18/2013 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Rotavirus |
| Date/Time Start of Administration | 11/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6359RV543 |
| Substance Expiration Date | 02/15/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Rotavirus |
| Date/Time Start of Administration | 03/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6359RV933 |
| Substance Expiration Date | 05/10/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Thigh Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Influenza |
| Date/Time Start of Administration | 09/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D8043IN8738 |
| Substance Expiration Date | 03/12/2013 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Influenza |
| Date/Time Start of Administration | 10/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D8043IN8798 |
| Substance Expiration Date | 03/12/2013 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Influenza |
| Date/Time Start of Administration | 10/30/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D9334IN9433 |
| Substance Expiration Date | 05/22/2014 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Influenza |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.25 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Sandra Molina |
| Substance Lot Number | D8043IN8855 |
| Substance Expiration Date | 08/28/2015 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 08/19/2014 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| Element | Data |
|---|---|
| Administered Code | Hepatitis A |
| Date/Time Start of Administration | 05/21/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6359RT35 |
| Substance Expiration Date | 01/04/2014 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Hepatitis A |
| Date/Time Start of Administration | 12/01/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6359RT47 |
| Substance Expiration Date | 09/11/2013 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Code | MMR and Varicella |
| Date/Time Start of Administration | 01/12/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7W27V7632 |
| Substance Expiration Date | 12/15/2016 |
| Substance Manufacturer Name | Merck Sharp and Dohme Corp. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
Following the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes the vaccine deferrals. The report MAY send the immunizations that the EMR imported from the IIS. |
The Report must include all vaccine deferrals recorded in the EMR in any order. The report may include the information imported from the IIS |
The vaccines for the visit have been administered. |
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries. |
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The message must contain all deferrals recorded in the EMR. Current Date is expected for the Non-Administration date and deferral date. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | Test EHR Application | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | X68 | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | NIST Test Iz Reg | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20120701082240-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | NIST-IZ-001.00 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Morales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Mariela | Test Case Fixed |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Gonzales | Test Case Fixed |
| PID.5.7 | Name Type Code | L | Test Case Fixed |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Gonzales | Test Case Fixed |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | Test Case Fixed |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 201505301115 | Test Case Fixed |
| PID.8 | Administrative Sex | F | Test Case Fixed |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | Test Case Fixed |
| PID.10.2 | Text | White | Test Case Fixed |
| PID.10.3 | Name of Coding System | HL70005 | Test Case Fixed |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 3321 Standish Way | Test Case Fixed |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | Test Case Fixed |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| PID.11.6 | Country | USA | Test Case Fixed |
| PID.11.7 | Address Type | L | Test Case Fixed |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 325 Shorline Drive | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06901 | |
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | BDL | Test Case Fixed |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| PID.13.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 203 | Test Case Fixed |
| PID.13.7 | Local Number | 5551214 | Test Case Fixed |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | Test Case Fixed |
| PID.22.2 | Text | Hispanic or Latino | Test Case Fixed |
| PID.22.3 | Name of Coding System | CDCREC | Test Case Fixed |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | ||
| PID.25 | Birth Order | ||
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/Recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | ||
| PD1.13 | Protection Indicator Effective Date | ||
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20120701 | |
| PD1.18 | Publicity Code Effective Date | 20120701 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Morales | Test Case Fixed |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Joanna | Test Case Fixed |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Gonzales | Test Case Fixed |
| NK1.2.7 | Name Type Code | L | Test Case Fixed |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | MTH | Test Case Fixed |
| NK1.3.2 | Text | Mother | Test Case Fixed |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 4623 Standish Way | Test Case Fixed |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Stamford | Test Case Fixed |
| NK1.4.4 | State or Province | CT | Test Case Fixed |
| NK1.4.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| NK1.4.6 | Country | ||
| NK1.4.7 | Address Type | L | Test Case Fixed |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| NK1.5.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 203 | Test Case Fixed |
| NK1.5.7 | Local Number | 5551213 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Sirtis | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lisa | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Carter | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Jane | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SH | |
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150530 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Sirtis | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lisa | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6332FK33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101214 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | Test Case Fixed |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | Test Case Fixed |
| RXA.5.2 | Text | DTaP, unspecified formulation | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | Test Case Fixed |
| RXA.5.2 | Text | Hib | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 152 | Test Case Fixed |
| RXA.5.2 | Text | Pneumococcal Conjugate, unspecified formulation | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 122 | Test Case Fixed |
| RXA.5.2 | Text | rotavirus, unspecified formulation | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30945-0 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC23 | |
| OBX.5.2 | Text | current fever with moderate-to-severe illness | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30946-8 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication/precaution effective date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30944-3 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination temporary contraindication/precaution expiration date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150815 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30945-0 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC23 | |
| OBX.5.2 | Text | current fever with moderate-to-severe illness | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30946-8 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication/precaution effective date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30944-3 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination temporary contraindication/precaution expiration date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150815 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30945-0 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC23 | |
| OBX.5.2 | Text | current fever with moderate-to-severe illness | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30946-8 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication/precaution effective date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30944-3 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination temporary contraindication/precaution expiration date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150815 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30945-0 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC23 | |
| OBX.5.2 | Text | current fever with moderate-to-severe illness | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30946-8 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication/precaution effective date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30944-3 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination temporary contraindication/precaution expiration date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150815 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30945-0 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC23 | |
| OBX.5.2 | Text | current fever with moderate-to-severe illness | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30946-8 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination contraindication/precaution effective date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30944-3 | Test Case Fixed |
| OBX.3.2 | Text | Vaccination temporary contraindication/precaution expiration date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150815 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Mariela Gonzales Morales |
| Mother's Maiden Name | Joanna Gonzales |
| ID Number | 123456 987633 |
| Date/Time of Birth | 05/30/2015 |
| Administrative Sex | Female |
| Patient Address | 3321 Standish Way Stamford CT 06903 USA |
| Patient Address 1 | 325 Shorline Drive Stamford CT 06901 |
| Local Number | (203)555-1214 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 07/01/2012 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 07/01/2012 |
| Protection Indicator | |
| Protection Indicator Effective Date |
| Element | Data |
|---|---|
| Name | Joanna Gonzales Morales |
| Relationship | Mother |
| Address | 4623 Standish Way Stamford CT 06903 |
| Phone Number | (203)555-1213 |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 05/30/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Lisa Sirtis |
| Substance Lot Number | 6332FK33 |
| Substance Expiration Date | 12/14/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, unspecified formulation |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | NA |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 07/15/2015 |
| Vaccination temporary contraindication/precaution expiration date | 08/15/2015 |
| Element | Data |
|---|---|
| Administered Code | DTaP, unspecified formulation |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | NA |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 07/15/2015 |
| Vaccination temporary contraindication/precaution expiration date | 08/15/2015 |
| Element | Data |
|---|---|
| Administered Code | Hib |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | NA |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 07/15/2015 |
| Vaccination temporary contraindication/precaution expiration date | 08/15/2015 |
| Element | Data |
|---|---|
| Administered Code | Pneumococcal Conjugate, unspecified formulation |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | NA |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 07/15/2015 |
| Vaccination temporary contraindication/precaution expiration date | 08/15/2015 |
| Element | Data |
|---|---|
| Administered Code | rotavirus, unspecified formulation |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | NA |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 07/15/2015 |
| Vaccination temporary contraindication/precaution expiration date | 08/15/2015 |
| Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.) |
| No Comments |
| Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered. |
| The patient/parent has been provided a patient immunization history report. |
| Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers. |
| No evaluation criteria |
| No Note |
|
Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.) |
No Comments |
|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered. |
|
The patient/parent has been provided a patient immunization history report. |
|
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers. |
The following patient demographics are displayed: Patient Identifier Number: Vendor Assigned
Patient Identifier Type Code: Vendor Assigned
Patient Name: Juana Mariana Gonzales
Date/Time of Birth: 12/23/2009 11:05am
Sex: Female
Patient Address: 4345 Standish Way, Stamford, CT, 06903
Multiple Birth: N
Birth Order: NA
The following Vaccination History is displayed:
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 12/23/2009
Additional Observations: None
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Jane Carter
Entered By: Lisa Sirtis
Entering Organization: Shoreline Hospital
Administered Amt: .05 mL
Administering Provider: Jane Carter
Administered at Location: 325 Shorline Drive,
Stamford Connecticut 06901
Lot#: 6332FK33
Exp Date: 12/14/2010
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 1/15/2010
Additional Observations: None
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Frank Smith
Entered By: Sandra Molina
Entering Organization: Shoreline Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shorline Drive,
Stamford Connecticut 06901
Lot#: 6352FK1
Exp Date: 10/1/2010
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 10/30/2010
Additional Observations: None
Dose #: 3
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6352FK24
Exp Date: 8/31/2012
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 1/22/2010
Additional Observations: None
Dose #: 1
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS2341
Exp Date: 11/30/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)
Date Administered: 3/23/2010
Additional Observations: 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose
Dose #: 2
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS2433
Exp Date: 9/4/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 5/22/2010
Additional Observations:
Dose #: 3
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS3255
Exp Date: 12/1/2010
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 2/21/2011
Additional Observations:
Dose #: 4
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS249
Exp Date: 3/1/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 1/22/2010
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M54K9245
Exp Date: 3/24/2010
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 3/23/2010
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M55K3342
Exp Date: 10/30/2010
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 5/22/2010
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M75K4566
Exp Date: 5/23/2010
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 2/21/2011
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M53K5534
Exp Date: 2/22/2011
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 1/22/2010
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D333PV2431
Exp Date: 10/4/2010
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 3/23/2010
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D333PV4344
Exp Date: 3/23/2010
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 1/22/2010
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P243V3281
Exp Date: 1/30/2010
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 3/23/2010
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P343V8321
Exp Date: 3/30/2010
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 5/22/2010
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P853V2164
Exp Date: 8/30/2010
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 2/21/2011
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P853V58532
Exp Date: 4/18/2011
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 1/22/2010
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RV533
Exp Date: 2/15/2010
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 3/23/2010
Additional Observations:
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RV932
Exp Date: 5/10/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 9/25/2010
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D8043IN8734
Exp Date: 3/12/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/27/2010
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D8043IN8734
Exp Date: 3/12/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/2/2011
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D9334IN9333
Exp Date: 5/22/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 11/4/2012
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D9553IN2243
Exp Date: 4/30/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: influenza, unspecified formulation
Administered: influenza, live, intranasal, quadrivalent (CVX 149)
FluMist Quadrivalent (NDC 66019-0301-10)"
Date Administered: Current Date
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .2 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: 8L4B3521
Exp Date: 7/15/2015
Manufacturer: MedImmune,LLC (MVX MED)
Route: Nasal (NCIT C38284), Nasal (HL70162 NS)
Site:
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 11/23/2011
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RT33
Exp Date: 1/4/2012
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Deltoid (HL7 RD)
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 5/23/2012
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RT48
Exp Date: 9/11/2012
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: MMRV
Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)
ProQuad (NDC 00006-4999-00)"
Date Administered: 10/23/2010
Additional Observations:
Dose #:
Doses in Series: 2
Valid Dose: N
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7W27V7491
Exp Date: 12/15/2010
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Thigh (HL7 LT)
Vaccine Group: MMRV
Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)
ProQuad (NDC 00006-4999-00)"
Date Administered: 11/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7W87V3452
Exp Date: 4/13/2013
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
Vaccine Group: MMRV
Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)
ProQuad (NDC 00006-4999-00)"
Date Administered: Current Date
Additional Observations: Reaction (LOINC 31044-1)/fever of >40.5C (105F) within 48 hours of dose (CDCPHINVS VXC12)
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: 7W87V3687
Exp Date: 7/15/2015
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
The Following Vaccine Forecast is displayed:
Vaccine Group: IPV
Due Date: 11/22/2013
Earliest Date to Give: 11/22/2013
Latest Date to Give: 11/22/2015
Overdue Date: 11/23/2015
Immunization Schedule: ACIP
Vaccine Group: influenza, unspecified formulation
Due Date: 10/21/2016
Earliest Date to Give: 9/1/2016
Latest Date to Give: 2/29/2017
Overdue Date: 3/1/3027
Immunization Schedule: ACIP
|
No Note |
| Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.) |
| No Comments |
| Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered. |
| The patient/parent has been provided a patient immunization history report. |
| Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers. |
| No evaluation criteria |
| No Note |
|
Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.) |
No Comments |
|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered. |
|
The patient/parent has been provided a patient immunization history report. |
|
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers. |
The following patient demographics are displayed:
Patient Identifier Number: Vendor Assigned
Patient Identifier Type Code: Vendor Assigned
Patient Name: Juan Marcel Gonzales
Date/Time of Birth: 11/23/2011 11:00am
Sex: Male
Patient Address: 4623 Standish Way, Stamford, CT 06903
Multiple Birth: N
Birth Order: NA
The following Vaccination History is displayed:
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 11/23/2011
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Jane Carter
Entered By: Lisa Sirtis
Entering Organization: Shoreline Hospital
Administered Amt: .05 mL
Administering Provider: Jane Carter
Administered at Location: 325 Shorline Drive,
Stamford Connecticut 06901
Lot#: 6332FK34
Exp Date: 12/14/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 12/23/2013
Additional Observations:
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6352FK2
Exp Date: 10/1/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: Current Date
Additional Observations:
Dose #: 3
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: 6332FK26
Exp Date: 8/25/2015
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL70162 LD)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS2342
Exp Date: 11/30/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS2434
Exp Date: 9/4/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 5/21/2012
Additional Observations:
Dose #: 3
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS3256
Exp Date: 12/1/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 5/21/2012
Additional Observations:
Dose #: 3
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS3256
Exp Date: 12/1/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M54K9255
Exp Date: 3/24/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M55K3343
Exp Date: 10/30/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 5/21/2012
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M75K4577
Exp Date: 5/23/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 11/22/2012
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M53K5535
Exp Date: 2/22/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D333PV2444
Exp Date: 10/4/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D333PV4343
Exp Date: 3/23/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 5/21/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D335PV9654
Exp Date: 2/22/2013
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P243V3321
Exp Date: 1/30/2012
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P343V8445
Exp Date: 3/30/2012
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 5/21/2012
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P853V2175
Exp Date: 8/30/2012
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 11/22/2012
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P853V58544
Exp Date: 4/18/2013
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RV533
Exp Date: 2/15/2010
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RV932
Exp Date: 5/10/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 9/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D8043IN8734
Exp Date: 3/12/2013
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/20/2012
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D8043IN8798
Exp Date: 3/12/2013
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/30/2013
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D8043IN8734
Exp Date: 5/22/2014
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: Current Date
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: D8043IN8855
Exp Date: 7/28/2015
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 5/21/2013
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RT35
Exp Date: 1/4/2014
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Deltoid (HL7 RD)
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 12/1/2013
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RT47
Exp Date: 9/11/2013
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: MMRV
Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)
ProQuad (NDC 00006-4999-00)"
Date Administered: 11/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7W27V7632
Exp Date: 12/15/2016
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Thigh (HL7 LT)
The Following Vaccine Forecast is displayed:
Vaccine Group: Dtap
Due Date: 11/22/2015
Earliest Date to Give: 11/22/2015
Latest Date to Give: 11/21/2017
Overdue Date: 11/22/2017
Immunization Schedule: ACIP
Vaccine Group: IPV
Due Date: 11/22/2015
Earliest Date to Give: 11/22/2015
Latest Date to Give: 11/21/2017
Overdue Date: 11/22/2017
Immunization Schedule: ACIP
Vaccine Group: Influenza
Due Date: 10/22/2015
Earliest Date to Give: 9/1/2015
Latest Date to Give: 1/31/2016
Overdue Date: 2/1/2016
Immunization Schedule: ACIP
Vaccine Group: MMR
Due Date: 11/22/2015
Earliest Date to Give: 11/22/2015
Latest Date to Give: 11/21/2017
Overdue Date: 11/22/2017
Immunization Schedule: ACIP
Vaccine Group: Varicella
Due Date: 11/22/2015
Earliest Date to Give: 11/22/2015
Latest Date to Give: 11/21/2017
Overdue Date: 11/22/2017
Immunization Schedule: ACIP
|
No Note |
| Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.) |
| No Comments |
| Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered. |
| The patient/parent has been provided a patient immunization history report. |
| Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers. |
| No evaluation criteria |
| No Note |
|
Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.) |
No Comments |
|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered. |
|
The patient/parent has been provided a patient immunization history report. |
|
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers. |
The following patient demographics are displayed:
Patient Identifier Number: Vendor Supplied
Patient Identifier Type Code: Vendor Supplied
Patient Name: Mariela Gonzales Morales
Date/Time of Birth: 03/30/2015 11:00am
Sex: Female
Patient Address: 3321 Standish Way, Stamford, CT 06903
Multiple Birth: Y
Birth Order: 1
The following Vaccination History is displayed:
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 11/23/2011
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Jane Carter
Entered By: Lisa Sirtis
Entering Organization: Shoreline Hospital
Administered Amt: .05 mL
Administering Provider: Jane Carter
Administered at Location: 325 Shorline Drive,
Stamford Connecticut 06901
Lot#: 6332FK34
Exp Date: 12/14/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
The Following Vaccine Forecast is displayed:
Vaccine Group: Hep B Peds NOS
Due Date: 6/29/2015
Earliest Date to Give: 6/29/2015
Latest Date to Give: 7/29/2015
Overdue Date: 7/30/2015
Immunization Schedule: ACIP
Vaccine Group: Dtap
Due Date: 7/29/2015
Earliest Date to Give: 29-Jul-15
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: Hib
Due Date: 7/29/2015
Earliest Date to Give: 7/29/2015
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: IPV
Due Date: 7/29/2015
Earliest Date to Give: 7/29/2015
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: Pneumococcal conjugate
Due Date: 7/29/2015
Earliest Date to Give: 7/29/2015
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: Rotavirus
Due Date: 7/29/2015
Earliest Date to Give: 7/29/2015
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: Influenza
Due Date: Nov 26, 2015 or later
later
Earliest Date to Give: Nov 26, 2015
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: HepA
Due Date: 5/29/2016
Earliest Date to Give: 5/29/2016
Latest Date to Give: 5/29/2017
Overdue Date: 5/30/2017
Immunization Schedule: ACIP
Vaccine Group: MMR
Due Date: 5/29/2016
Earliest Date to Give: 5/29/2016
Latest Date to Give: 8/27/2016
Overdue Date: 8/28/2016
Immunization Schedule: ACIP
Vaccine Group: Varicella
Due Date: 5/29/2016
Earliest Date to Give: 5/29/2016
Latest Date to Give: 8/27/2016
Overdue Date: 8/28/2016
Immunization Schedule: ACIP
|
No Note |
The provider periodically uses the EMR to identify the cohort of patients that are overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents. |
No Comments |
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. The vaccine forecast is available to the EMR. |
The Cohort report for all patients that are overdue for immunizations is available to the provider through the EMR. |
Produce Population-Level Report: The EHR or other clinical system generates aggregate, population-level reports based on known patient immunization data. |
The following patient information is provided on the cohort report:
|
No Note |
The provider periodically uses the EMR to identify the cohort of patients that are overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents.
|
No Comments |
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. The vaccine forecast is available to the EMR.
|
The Cohort report for all patients that are overdue for immunizations is available to the provider through the EMR. |
Produce Population-Level Report: The EHR or other clinical system generates aggregate, population-level reports based on known patient immunization data. |
The following patient information is provided on the cohort report:
|
No Note |